Cognitive Behavioral Therapy for Narcissistic Personality Disorder
If you or someone you know has narcissistic personality disorder (NPD), then you may be familiar with some of the challenges that can accompany this condition. An individual with narcissistic personality disorder often has an inflated sense of their own importance, seeing themselves as superior to others. Someone with NPD may also have difficulty recognizing and empathizing with other people’s feelings. Given these dynamics, NPD can make it difficult to form and maintain healthy relationships with others. Still, treatment can help. NPD can be treated through psychotherapy such as cognitive behavioral therapy (CBT), for instance.
An overview of cognitive behavioral therapy for narcissistic personality disorder
Cognitive behavioral therapy, or CBT, is a common type of talk therapy that can help people identify unhelpful thought patterns and behaviors and replace them with healthier alternatives. Cognitive behavioral therapy (CBT) has been extensively researched and found to be an effective treatment for several mental health concerns and conditions, such as depression, anxiety, eating disorders, and relationship conflict, for example.
As noted by the American Psychological Association, CBT has been shown to be just as or more effective than other types of therapy or psychiatric medication. It is based on core principles that include:
- Psychological problems are at least partly based on unhelpful ways of thinking and unhelpful patterns of behavior.
- People experiencing psychological problems can learn coping strategies that reduce their symptoms and improve their day-to-day functioning.
Cognitive behavioral therapy (CBT) is designed to help people reverse cognitive distortions, which are those unhelpful thoughts and behaviors that lead to unhealthy behaviors. A few common cognitive distortions are:
- Catastrophic thinking
- Discounting the positive
- Jumping to conclusions
- Mental filtering
- Black-and-white thinking
- Overgeneralizing
Cognitive behavioral therapy (CBT) is typically a short-term treatment, often comprised of around five to 20 sessions. Still, you can work with your therapist to determine how many therapy sessions you need. The duration of therapy may depend on the severity of your symptoms, how long you’ve been experiencing your condition, your current stress levels, and how receptive you are to change, for instance.
Narcissistic personality disorder signs
An individual with narcissistic personality disorder (NPD) may have an inflated sense of their own importance and little regard for others. Someone with NPD may seem to need excessive attention, praise, and compliments, and deep down, they may feel insecure and have low self-worth. It is estimated that the condition affects around 1 to 6% of the population.
To be diagnosed with NPD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person must exhibit at least five of the following symptoms:
- Possesses a grandiose sense of self-importance
- Preoccupation with success, power, brilliance, beauty, or perfect love
- Belief that they are special and should only associate with other special people
- Entitled, with unreasonable expectations of favorable treatment
- Exploits others to get what they want
- Displays arrogance and haughty behaviors
- Envious of others, or believes people are envious of them
- Needs excessive admiration
- Has no empathy and demonstrates no concern for the needs of others
To diagnose narcissistic personality disorder, a clinician must examine long-term patterns of functioning. People with NPD may also experience other mood and personality disorders, like borderline personality disorder.
How is CBT used for narcissistic personality disorder?
Themost common treatment for NPD is psychotherapy. There are currently no medications available to treat the condition. However, since NPD is often accompanied by other mental health conditions such as anxiety or depression, medication may be used to treat these other disorders.
Some common symptoms of NPD—such as difficulty listening to feedback, feelings of entitlement, and a reluctance to admit shortcomings—may make it difficult for someone with NPD to actively participate in therapy. Still, when someone with NPD seeks behavioral therapy such as CBT, treatment may help reduce their symptoms.
During CBT for narcissistic personality disorder, therapists may use several techniques to help patients adopt a healthier way of thinking.
Restructuring
This technique involves identifying negative thought patterns and then reframing them to be more positive and productive. There is a five-step framework that can guide this approach:
- Identify the upsetting situation.
- Identify the most upsetting or irrational feeling from that situation.
- Identify thoughts about the situation that underlie the feelings.
- Evaluate the accuracy of the upsetting thought.
- Decide whether the upsetting thought is accurate, and then take action accordingly.
Cognitive restructuring can be used to reshape cognitive distortions commonly associated with NPD such as black-and-white thinking and magnification, for example.
Exposure
Exposure therapy can help people confront specific fears. For someone with NPD, this may require them to put themselves in situations that challenge their self-importance or to display empathy and care for other people.
Journaling
Through journaling, someone with NPD may be able to observe their thoughts from a more objective point of view by revisiting them after they’ve occurred. Individuals may be asked to record negative thoughts or perceptions regarding interactions with various people. This allows them to identify potentially troubling thought patterns and work with the therapist to change them.
Role playing
During role-playing, the therapist and patient can work through behaviors that the patient may present in various situations. For example, the therapist could pretend to be someone the patient meets at an event, and the individual with NPD can practice asking questions about the other person, rather than only talking about themselves.
Behavior experiments
Behavioral experiments can help a person test and modify inaccurate beliefs. For example, a person with NPD may participate in a discovery experiment where they learn more about a situation outside of their own beliefs.
Skills training
Skills training may include behavior rehearsal, relaxation training, or social skills training, for example. Through this strategy, the patient may learn to act more appropriately in a variety of social settings.
Guided discovery
During guided discovery, a therapist may try to learn more about the patient’s beliefs, then ask open-ended questions designed to challenge those beliefs. Often, the goal here is to ask questions that allow information to be brought to the patient’s awareness. From there, the individual can begin to consider the problems they are facing as well as potential solutions.
Psychoeducation
Like with other personality disorders, like borderline personality disorder, someone with NPD may not be fully aware of their symptoms or how they impact others. Through psychoeducation, the patient can learn more about narcissistic personality disorder and how it impacts their thoughts and behaviors.
How online therapy can help
Some individuals with NPD may experience symptoms that might make engaging in therapy feel difficult. For instance, they may be worried about how others might perceive them if they are observed seeking help. In such cases, online therapy may offer a convenient alternative. Online therapy can be conducted anywhere that an individual has internet such as their home, for instance, eliminating the need to travel to a counseling office and interact with others there.
Online therapy has been shown to be an effective treatment option for a range of mental health concerns, and there is strong evidence supporting the effectiveness of online CBT in particular. For instance, one study conducted an overview of the effectiveness of internet-based CBT (ICBT) in the treatment of psychiatric disorders, and it concluded that “ICBT is useful in treating mental health and medical illnesses with psychiatric comorbidities”.
Takeaway
Someone with narcissistic personality disorder may have an inflated sense of their own importance and expect preferential treatment. This can be detrimental to relationships and other areas of a person’s life. However, cognitive behavioral therapy can help shift these unhelpful thoughts and beliefs to decrease the symptoms associated with NPD and improve daily functioning. If an individual with NPD is hesitant to seek treatment due to what others might think of them, online therapy may be a beneficial alternative. To get started on your therapeutic journey or to seek help for a loved one, reach out to BetterHelp today.
What is the root cause of narcissistic personality disorder (NPD)?
The exact cause of narcissistic personality disorder is not known, but it is believed to be based on a combination of factors, including genetics and a history of childhood abuse, among other factors. NPD affects one's self esteem system and creates unhealthy cognitive behavioral mechanisms.
Does a narcissist know they are a narcissist?
Narcissists suffer from unhealthy narcissistic self esteem, so they are typically not aware that they exhibit maladaptive patterns of behavior and have maladaptive belief systems.
How do you approach a narcissist about their behavior?
Can confronting a narcissist with reality threaten self esteem or incite self esteem dysregulation? The answer is yes: a narcissistic person has unhealthy self esteem, so you may witness self esteem levels fluctuating if you confront them. Because of this, they may not be able to regulate difficult emotions emerging from being confronted (narcissistic self esteem dysregulation). For these reasons, it is important to be gentle with them while still setting boundaries to protect yourself. Focus on their behaviors rather than on who they are, and realize that it is not your fault if they attack you for bringing up these behaviors.
Can therapy fix a narcissist?
Therapy can’t “fix” a narcissist, but it can, in some instances, help people recognize their maladaptive beliefs and their problems with interpersonal relationships. However, a person with NPD can be resistant to therapy because it may challenge them to transform maladaptive belief systems, generating substantial anxiety, and being confronted with reality may threaten core beliefs about themselves and crack their brittle self esteem.
Do narcissists agree to therapy?
Many narcissists will not agree to therapy because they don’t believe they need it. Some narcissists do agree to attend therapy, but they don’t always benefit from the therapeutic process because they can perceive self-investigation as creating self esteem threats.
Can someone with NPD change if they go to counseling?
According to the American Psychiatric Association, a person with narcissistic personality disorder can change with help from mental health professionals, although improvement can be slow.
Are people with NPD able to get help from counseling?
Treating NPD is difficult, although not impossible, because many people with NPD believe they don’t need therapy, or they attempt to please the therapist. They also may not be able to regulate difficult emotions that arise during therapy and relate to the person’s self esteem, in which case the therapist also has to treat narcissistic dysregulation. The cognitive behavioral model of therapy is often used.
What type of treatment is best for people with NPD?
Current research claims that psychodynamic therapy is the best type of therapy for NDP. Cognitive behavior therapy is another common evidence-based modality used for NPD, as are transference focused psychotherapy, schema therapy, dialectical behavior therapy, and cognitive therapy. They can all examine a person’s social psychological attitudes and help with mental health promotion and restore self esteem.
Does cognitive behavioral therapy for narcissistic personality disorder work?
Treating narcissistic personality disorder with cognitive behavioural therapy can be effective in some cases. Although progress can be slow, it can help foster positive self regard and healthier interpersonal functioning. Therapists use cognitive behavioral formulation to delve into the roots of a person’s NPD.
Does CBT work to help people with personality disorders?
Empirical support has shown that cognitive behavioral treatments can work for people with personality disorders, because they challenge the person to rethink their cognitive and behavioral habits and help people to develop more positive self regard and work on healthy self esteem. CBT can also be helpful for people experiencing bipolar disorder, major depressive disorder, and anxiety disorders such as social anxiety disorder. General cognitive behavioral therapy can help people who don’t suffer from mental health disorders and have even healthy self esteem levels.
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